Managing Managed Care

Our inequitable, inefficient, oftentimes uncaring health care "system," revealed. -- Jeffrey G. Kaplan, M.D., M.S.

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Reducing Economic Pain

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The "areas in which the proper reform measures could generate savings that could pay for universal coverage" include, but are not limited to unecessary and presumably unhelpful care, fraud and from the perspective of the physician, extraneous administrative expenses. Unnecessary care is believed to be responsible for as much as 30% of health care spending,2 or up to $830 billion this year alone.

The 4 Main Reasons We Fail Reforming Health Care: Cost Fears, Variation, Poor Collaboration and Understanding

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Approximately 2/5 persons don't understand their insurance coverage, i.e., which healthcare services are being covered under their current plan and, 1 in 5, "have avoided visiting a doctor for a general health concern within the past 12 months because of cost concerns."

When's "Good" Quality, Good Enough?

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A payer judges a physician or a practice organization by the proportion of patients for which the physician adhered to one or more abstract practice measures. Those in quality measurement seem to be attempting to align the clinical quality measures that are relevant to Electronic (EHR) Incentive Programs.  Isn't that artificial and once removed from the patient's care?

Cost is the Big Item in the Value Equation of Health Care and Here's Why

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The main tension about healthcare centers around medical need, quality, access and cost-efficiency, i.e., affordability. To increase "value," one must raise quality, improve access and/or lower the cost of care. 

Not Just an Apple a Day...

“There’s no such thing as alternative medicine [when it comes to "fighting" cancer]. There’s only medicine that works and medicine that doesn’t."   Complementary and Alternative Medicine (CAM) is inviting and has such promise but it is unproved and it can be dangerous. As Paul Offit (Chief Infectious Diseases, Children’s Hospital of Philadelphia) states, “There’s no such thing as alternative medicine. There’s only medicine that works and medicine that doesn’t.”

Real Reform

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The strategic agenda for real reform lies in creating a value-based health care delivery system. As stipulated by Porter and Lee in 2013, health care will be organized and paid for differently in the near future.  Six critical steps in reform as as follows [modified]: Separate primary from preventive care; reorganize care around patient medical or surgical conditions, forming what they call “Integrated Practice Units” (essentially team work);

"Health Care" and "Insurance Companies"--Oxymoron

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"I don't understand why health care and insurance companies keep appearing in the same sentences." (Fisher, W. Truthout 10/25/09) Isn't it frustrating to have to live under employment based health care insurance?  If you lose your job, your employer wants to cut back, or you are a peasant, you're screwed!  Also, as a result of the way we are paid and the insurance model itself, there are many forces today that steal us away from the exam table or bedside.

Med School Doesn't Teach This

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What new docs need to know and never learned in medical or osteopathic school Harvard Medical School's Top Health Headlines of 2015 as reported in HEALTHbeat, on Twitter, and in their blog. (To read any of these articles or patient education pieces, please go to their website: www.health.harvard.edu/ and/or get a free subscription by registering there.)   Top 5 HEALTHbeat articles How stretching keeps your joints moving Exercise: An effective prescription for joint pain

Heart's Not Healthy? Recouping Tips

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When it comes to health, the better-informed patient does better—Duh! What is a patient to do to reverse or ameliorate heart failure, that is, besides taking meds? ABSTRACT failed to work 5/27/16]pan> Context Little is known about the effects of low health literacy among patients with heart failure, a condition that requires self-management and frequent interactions with the health care system.

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